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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER (� TELEPHONE %�/ _ t9Opa �< <br /> Q267r/ ID �J G .J o <br /> MAILING ADDRESS / 1C�C� J E <br /> SAp <br /> o <br /> C <br /> PROPERTY ADDRESS : <br /> ,�I O Q.// �tsC \ � O <br /> LEGAL DESCRIPTION ( g,76 r/ <br /> t L, <br /> SINGLE FAMILY DWELLING D GARAGE/ CCESSOR S RUCT E D ADDITION D STAIR5;K, --- <br /> TYPE OF PERMIT(S): <br /> .. ,a <br /> FILLING/GRADING ❑ CAMPING UNIT❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ <br /> STRUCTURE/ADDITION USE: 6fa;�.S Z <br /> (Home///Cabin; Commercial Business; Bedroom; Deck; etc.) o <br /> BUILDING CONTRACTOR: J A CyE gC1'V If. D ' 80)( a� (\` R <br /> Rj <br /> rlowlke , C toll5 f8 XJ <br /> A PLOT PLAN MUST BE PROVIDED ON AN 81h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS G <br /> WILL BE RETURNED. O 3 <br /> 0 < <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 0 — <br /> 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. turf d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW c R <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDIN (S) �� W c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK U� <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. N y <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 0 o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE 4 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> ..I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: �- <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ' z L't Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ri 'p <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. !n ^C <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE O LY. <br /> NOT TO BE USED FOR HUMAN HABITATION. F <br /> 6. <br /> � gyanmOao -0 <br /> 7. a m yv H c <br /> 3 '0�w= y ? w <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowledge <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information o G? <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree to n pn <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- o <br /> described premises at any reasonabl for the purpose of Inspection. cQ ER <br /> = y <br /> 6 <br /> OWNER'S SIGNATURE <br /> '74? <br /> (date) ?� �y N nw= t'Ms'1 <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> aim;l 4 let�-u mai(ed k Joe Cvexso-) ?-3o <br />